Disrupting pathways to negative outcomes in children and adolescents who have caregivers with Substance Use Disorder (SUD) is of the highest priority if we are to gain control over the opioid epidemic. This population is at very high risk for becoming the next generation of individuals with SUD, as well as other types of psychopathology and eventual juvenile/criminal justice involvement. In addition to experiencing severe/chronic adversities during their development, these youth are now further propelled toward these negative trajectories due to the COVID-19 crisis which substantially compounds the issues (e.g., estrangement from otherwise normalizing social influences, such as school, nondelinquent peers, extended families, health care, etc.) for both the young person and the parent with SUD. We review the literature establishing the linkages between adverse childhood experiences (ACEs) and pathways to SUD. Our focus is particularly on opportunities for intervention across development using family-based programs that directly address parenting skills and trauma. Invoking structural level change to merge SUD treatment and evidence-based family intervention infrastructures in communities promise to both reduce externalizing behaviors and internalizing symptoms in these youth, as well as reinforce recovery in the parents. Currently, these systems do not intersect, thus, children do not often receive programming and treatment of caregivers for SUD is less effective without engagement of the family unit.

Key Take Away Points

  • Children of caregivers with Substance Use Disorder (SUD) are at high risk for developing SUD themselves
  • These children experience adversity and trauma, which is the link to negative developmental and behavioral outcomes
  • Evidence-based parenting and family interventions are available that have potential to disrupt pathways to SUD, preventing these children from developing SUD
  • Trauma-informed approaches are critical to improve outcomes
  • Providing both treatment for parents with SUD and family intervention is essential to improve child outcomes and reinforce recovery in the parent
  • Web-based interventions have potential to reach otherwise hard-to-reach populations
  • Education of professionals who work with these families is a critical component
  • National and local policies should be informed by this science

Author Biography

Dr. Fishbein is the Director of Translational Neuro-Prevention Research in the FPG Child Development Institute at University of North Carolina. She is also part-time research faculty in the Department of Human Development and Family Studies at The Pennsylvania State University. She hold positions as Adjunct Professor at University of Maryland School of Medicine, Johns Hopkins University and University of California, Irvine, as well as a faculty subcontractor at Georgetown University, and a Guest Researcher at the National Institute on Drug Abuse Intramural Research Program. Dr. Fishbein’s studies use transdisciplinary methods and a developmental approach to understanding interactions between neurobiological processes and environmental factors. Her research supports the premise that underlying neurobiological mechanisms interact with the quality of our psychosocial experiences and environmental contexts to alter trajectories either towards or away from risk behaviors. Her work further suggests that compensatory mechanisms can be strengthened with the appropriate psychosocial and environmental manipulations. She has published extensively and serves in an advisory capacity for federal and state government bodies as well as several universities and organizations. Given the inherent translational nature of this research, she founded and directs the National Prevention Science Coalition for Improving Lives (NPSC), a national organization dedicated to the transfer of knowledge from the basic sciences to practices in real world settings and public health policies. Through dissemination and advocacy, she actively informs the decision-making of federal and state level policymakers and agency administrators about the value and utility of prevention science to increase uptake of best practices.


This work is currently funded by the Office of National Drug Control Policy (ONDCP) through the University of Baltimore (Award Number (FAIN): Gl999ONDCP06A)